One Dose Does Not Fit All

With antibiotic-resistant pathogens posing an ever-larger threat, demand is rising for better ways to tailor dosing more precisely to the individual – especially for children with special medical needs.

But discovering what those ideal doses may be will require more frequent and sophisticated testing than many physicians and hospitals provide today, according to a review study led by researchers at Cincinnati Children’s.

The paper describes which antibiotics are most commonly used in children and how dose levels that are effective for adults do not necessarily have the same effect in children. Not only do children vary widely in body mass as they grow, their metabolism rates change as their organs develop. Accurate antibiotic dosing also can be affected when children have chronic conditions such as cystic fibrosis or immune disorders.

However, many antibiotics have been studied only in adults. With a lack of pediatric data, the authors say it becomes all the more important to have accurate measurements of drug concentrations in the blood and adjust doses accordingly. Yet most hospitals measure drug concentrations only for the sickest patients and only for a few antibiotics, such as aminoglycosides and vancomycin.

“Ultimately, knowledge of how to use an antibiotic appropriately is as important as knowing which antibiotic to choose,” the study authors write. “In the years to come, the importance of dose optimization will become even more evident.”

When Less Can Be More

David Haslam, MD, Director of the Antimicrobial Stewardship Program at Cincinnati Children’s, describes how the medical center is changing its practices to combat drug-resistant infections. Prescribing antibiotics less frequently and taking “time outs” to determine whether patients still need the most powerful antibiotics is reducing rates of drug-resistant infection while avoiding any increases in poor outcomes. Watch this video for more information.